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1527286 tn?1292793687

DCIS with comedo necrosis questions

I was diagnosed with DCIS with comedo necrosis on Nov 11th.  I went back to the hospital and had a stereotactic needle biopsy (12 ) that found the DCIS. I met with a surgeon that works with the breast center and he ordered an MRI that indicated an additional area of concern "close" to the biopsied site. He scheduled surgery, I had blood work done and met with a radiation oncologist. My surgery had been scheduled for Dec 6th. with a planned sentinel node biopsy.

In the interim I decided to go to a much larger city with a well know breast cancer center for a second opinion.  I met with the surgeon who read the MRI results and asked "what" was the second area.  She felt we needed to know before we just removed it as removing it would be a much larger area. She sent me immediately to have a sonagram which led to biopsies of two additional sites.  A long night's wait and I found out the other sites were benign and did not need to be removed.  

Surgeon #2 said I was a great candidate for lumpectomy and brachytherapy radiation treatment.  If the additional sites had been removed brachytherapy was off the table.  She also told me that I did not need a sentinel node biopsy now as the DCIS was caught very early and if needed, a sentinel node biopsy could be done later.

I have had radiologists and surgeons tell me that once a breast has had a lumpectomy that you can no longer rely on OR do a sentinel node biopsy.  I am having difficulty resolving these contradicting statements made by medical professionals.  How do I decide if I have the sentinel node biopsy or not?  any information will be greatly appreciated.  Thank you.
4 Responses
25201 tn?1255584436
First may I ask that in the future you combine all your posts by adding a comment to your original post so that we have all the information in one place; easier not to miss something when we answer.
Evidently you have gotten opinions from possibly even more than the two you mentioned in your post so I would advise you to rely upon the opinions of the experts in making your decision as to node testing. If you have only received two opinions and they are opposing then you are entitled to a third to obtain some agreement. I wouldn't continue to delay over a small issue such as the sentinel node sampling. Ductal Carcinoma InSitu is contained within the original site so the need for node sampling is definitely questionable. Good Luck ...
1527286 tn?1292793687
I apologise for the double entry. I have seen two surgeons. I had a lumpectomy on Dec 10th, and was told I was a good candidate for brachy therapy, so a spacer was placed during surgery.  Mamosite scheduled for Tues Dec 14 but path came back with multifocal disease with an additional 4mm tumor of invasive cancer. The spacer was removed and I met with my surgeon who recommended a single mastectomy with a lift on the unaffected side.  I am scheduled for my mastectomy and reconstruction using expanders on my right breast.  The lift of my left will be done during the final surgery when the expander is removed.

I am struggling with making a decision on whether to have a single or double mastectomy.
I have read everything I can, I have spoken with lots of people and there seems to be an underlying sentiment that the double mastectomy would give the best results.  But what about sensation and feeling.  Is it better to keep one breast that has a slight change of having cancer at some later date and go thru the pain of the expanders again?  Any imput appreciated.  Thank you for your response.  I feel very confident with my team and the plastic surgeon is highly recommended and accomplished.  Thank you again.
962875 tn?1314213636
This  is indeed a very difficult and personal decision!

The immediate reaction of may women is: "Take them both off!" because they want to lower the risk of ever having to deal with breast cancer again.

Others, and perhaps esp. those for whom breast stimulation and sensation plays an important role in their enjoyment of sensual and sexual activities, prefer to retain the healthy breast.

Some additional factors that might be taken into consideration are: whether the type of invasive BC you have has an elevated  risk for recurring in the contralateral breast; how aggressive the grade of your tumor is; and whether you are willing to maintain the ongoing close surveillance (mammos? MRIs? U/S? --difficult to say, since as I understand it, your invasive componet didn't show up until the path. from the lumpectomy came back?) that would likely be recommended for the healthy breast.

When I noticed that you hadn't had any replies to your request for imput on the issue, I wanted to make sure you know that others understand that this is by no means an easy decision... (You probably have already thought of all of this, but perhaps it will be helpful to others facing the same decision.)

I am glad you have a treatment team that you trust and  have available an accomplished plastic surgeon for your reconstuction(s).   If you haven't fully researched yet all of the types available, you might want to take a look at the excellent coverage of this subject by SueYoung55 in a couple of previous threads:

http://www.medhelp.org/posts/Breast-Cancer/Trans-flap-vs-implants/show/1308880?personal_page_id=384050

http://www.medhelp.org/posts/Breast-Cancer/Single-or-Double-mastectomy/show/1347293?personal_page_id=814224#post_6154256


Best wishes...
962875 tn?1314213636
p.s. If you do decide on bilateral mx, here is another previous thread with lots of advice from our members.

http://www.medhelp.org/posts/Breast-Cancer/How-can-I--prepare-for-my-bilateral-mastectomy/show/1227057?personal_page_id=384050#post_5678838

bluebutterfly
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